Research and analysis

HPR volume 12 issue 19: news (1 June)

Updated 21 December 2018

Revised CBRN manual for emergency responders and front-line healthcare professionals

Public Health England (PHE) has published a new CBRN incidents manual, representing the first full revision of advice originally published in 2006 by the (then) Health Protection Agency.

Chemical, Biological, Radiological and Nuclear Incidents: Clinical Management and Health Protection [1] is primarily intended for first responders and front-line healthcare professionals in emergency departments but also for those in other specialties, including primary care and public health, emergency planners, trainers, and emergency service personnel. It comprises five sections covering:

• generic incident management principles
• chemical, biological and radiation threats, respectively, and
• a new, final section covering health protection considerations applicable to mass casualty situations, such as following bomb blasts (for example appropriate management of blood-borne virus transmission risk, antibiotic prophylaxis for bomb injury wounds and following biological agents release, etc)

Guidance on chemical and biological threats given in the 2006 edition has been updated with additional material on a range of new and emerging threats. These 2 sections include disease, syndrome or agent-specific advice sheets that can be used as stand-alone items, to be printed out and used by those responding to identified deliberate-release threats (overt or covert).

For example, the biological threats section includes a dozen disease-specific advice sheets (ranging from brucellosis to viral haemorrhagic fevers) and provides guidance on differential diagnosis of unusual infections and of important syndromic presentations. The chemical threats section includes an algorithm for ‘rapidly evolving chemical exposure syndromes’ and a dozen chemical and toxin-specific advice sheets. It also explains the primary function of the National Poisons Information Service’s Toxbase facility for healthcare professionals responding to chemical poisoning incidents and provides an overview of chemical hazard labelling schemes for transport and supply, and EPA-promulgated exposure limits for emergency situations.

The radiation incident response section has been completely re-written to integrate the European Society for Blood and Marrow Transplantation’s rapid clinical assessment tool with care pathways derived from the WHO global consensus guidelines on radiation injury.

The revised CBRN manual is the product of experts from the UK National Health Service, the Defence Medical Services and PHE. The guidelines on the management of chemical casualties was reviewed by the NPIS; and the contents of the whole document by NHS England’s Emergency Preparedness and Response Clinical Reference Group.

Reference

1. PHE (May 2018). Chemical, biological, radiological and nuclear incidents: clinical management and health protection (second edition).

Infection reports in this issue of HPR

This issue includes reports on:

• Laboratory confirmed cases of measles, rubella and mumps, England: January to March 2018
• Laboratory reports of respiratory infections in England and Wales: weeks 18 to 21, 2018